绝经后无症状子宫内膜增厚女性的内膜细胞病理学特征及临床意义  

Cytopathological features and clinical significance of endometrium in asymptomatic postmenopausal women with endometrial thickening

作　　者：吕淑兰[1] 师赞 薛雪 贺永艳 王晓林 曹杨 周杨[3] LV Shulan;SHI Zan;XUE Xue;HE Yongyan;WANG Xiaolin;CAO Yang;ZHOU Yang(Department of Gynaecology and Obstetrics,First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Reproductive Medicine,Northwest Women and Children’s Hospital;Department of Gynaecology,Affiliated Hospital of Northwestern Polytechnical University)

机构地区：[1]西安交通大学第一附属医院妇产科,西安714061 [2]西北妇女儿童医院生殖医学科 [3]西北工业大学医院妇科

出　　处：《山西医科大学学报》2021年第1期107-112,共6页Journal of Shanxi Medical University

基　　金：西安市科技计划项目[2017117SF/YX011(3)];白求恩·中青年医生优才培养计划-女性健康科研项目(HX202046)。

摘　　要：目的通过对绝经后无症状子宫内膜增厚(≥4 mm)女性的子宫内膜细胞病理学结果进行分析,描述该人群子宫内膜细胞病理学特点,寻求最佳的绝经后无症状子宫内膜增厚的临床处理厚度界点。方法收集2016年10月至2017年10月期间在西安交通大学第一附属医院妇产科就诊的绝经≥1年、无明确症状(阴道流液、流血、腹痛等)的子宫内膜≥4 mm的患者,进行子宫内膜厚度测量及子宫内膜细胞病理学取样。结果59例绝经后无症状子宫内膜增厚患者的子宫内膜细胞病理学显示:子宫内膜良性改变者共56例(95%),其中萎缩性子宫内膜组20例(34%),增生性子宫内膜组36例(61%);子宫内膜癌共3例(5%)。不同细胞病理学组间年龄、BMI、绝经时长差异存在统计学意义(P<0.05),子宫内膜厚度及糖尿病、高血压患病情况差异无统计学意义(P>0.05)。绝经后无症状子宫内膜增厚患者子宫内膜厚度界点(cut-off point)为≥9 mm时诊断效能较好,诊断子宫内膜癌的灵敏度为100%,特异度为64.3%,约登指数为0.6。结论绝经后无症状子宫内膜增厚女性子宫内膜细胞病理学表现以良性为主。绝经后无症状子宫内膜增厚者内膜厚度界点为≥9 mm时,对于子宫内膜癌及癌前病变具有较好的诊断效能。Objective To investigate the cytopathological features in postmenopausal women with asymptomatic endometrial thickening(≥4 mm),and to seek the best cut-off point of endometrial thickness.Methods Patients with menopause for over at least one year and endometrium≥4 mm without definite symptoms(vaginal discharge,bleeding,abdominal pain,etc.)were collected from October 2016 to October 2017 in the Department of Obstetrics and Gynecology,the First Affiliated Hospital of Xi’an Jiaotong University.The endometrial thickness was measured and endometrium was taken for cytopathology.Results Of 59 patients with asymptomatic endo-metrial thickening after menopause,the endometrial cytopathology showed benign changes in 56 cases(95%),containing 20 cases of atrophic endometrium and 36 cases of proliferative endometrium,and endometrial cancer in 3 cases(5%).There was significant difference in age,BMI and duration of menopause among different cytopathological groups(P<0.05),but there was no significant difference in the endometrial thickness and the prevalence of diabetes and hypertension(P>0.05).When the cut-off point of endometrial thickness in women with asymptomatic endometrial thickening after menopause was≥9 mm,the sensitivity for diagnosing endometrial cancer was 100%,the specificity was 64.3%,and the Norden index was 0.6.Conclusion Endometrial cytopathology in postmenopausal women with asymptomatic endometrial thickening is mainly benign.When the cut-off point of endometrial thickness of asymptomatic endometrial thickening after menopause is≥9 mm,it has better diagnostic efficacy for endometrial carcinoma and precancerous lesions.

关 键 词：绝经后无症状子宫内膜增厚 细胞病理学 内膜厚度界点 

分 类 号：R711[医药卫生—妇产科学]